When couples are preparing for IVF or ICSI, much of the focus is often placed on ovarian reserve, egg quality, and treatment protocols. However, male fertility plays an equally important role in determining fertilisation, embryo development, and treatment outcomes.
Male fertility testing before treatment helps identify factors that may influence success, guides the choice of treatment, and ensures that potentially correctable issues are not overlooked. This guide explains what testing involves, why it matters, and when further assessment may be beneficial.
Which Techniques Exist
Although ICSI was originally developed to overcome male factor issues by injecting sperm directly into the egg, the Embryologists carrying out he ICSI cannot determine which sperm have normal DNA because this cannot be seen down the microscope.
Some techniques can help increase the incidence of sperm available for ICSI with good DNA integrity by negatively selecting against poorer sperm during preparation or selection.
Zymot or Spermcount (costs £150-£800)
Both of these devices have a little net which allows well formed and motile sperm to swim through, but doesn’t allow dead, poorly formed or poorly swimming sperm to get past – this ensures sperm used for the ICSI (or IVF) are the ‘crème de le crème’ and therefore should have the best DNA integrity. A ‘Zymot prep test’ (£650) can be done at Acorn Andrology if this is something you would like to test prior to an ICSI cycle, where a Sperm DNA Fragmentation test is done both before and after the Zymot prep in order to measure the reduction in Sperm DNA Fragmentation level in advance. Zymot prep can also eliminate the need for density centrifugation of sperm in the lab, which can actually induce Sperm DNA damage, therefore exacerbating the issue.
PICSI (costs around £700)
Physiological ICSI – relies on a special dish being used at the time of ICSI which has Hyaluronan plaques attached. These plaques allow the prepared sperm to swim over and around them and those sperm with the correct receptors for Hyaluronan will attach to the plaque as they would the cells surrounding an egg. Immature sperm do not have these receptors, and mature sperm have the best DNA integrity, therefore allowing the Embryologist to pluck off from the plaque the sperm that are most mature for use in the ICSI.
Neither of these techniques can guarantee 100% fertilisation rates or even improved Blastocyst development rates, but in theory, they could help improve both.
In Conclusion
Male fertility testing before IVF or ICSI is a critical part of comprehensive fertility care. A structured assessment of Sperm DNA Fragmentation, along with Semen Analysis, can help guide treatment decisions and supports the best possible outcomes.
Even in the era of advanced assisted reproductive technologies, understanding and optimising sperm health remains an important step in personalised fertility treatment.